Athletic Injuries

Rachel Askin, Seth Bohler, Holley Eberth, Joseph Gaudino, Hank Nathan, Karissa M. Page, Michael Shea

Whether it is running, skiing, punting, or pirouetting, the human knee facilitates the complex moves needed to engage in not only everyday life, but all varieties of athletics. However, knee injuries are on the rise. According to the Centers for Disease Control and Prevention, approximately 19.4 million visits were made to physicians offices in 2003 for knee problems; knee problems were also the most common reason for visiting orthopedic surgeons. Because there are many components to the knee, it is particularly vulnerable for a variety of injuries. The most common types of injuries are those associated with the ligaments of the knee.

The human knee is the hinge joint connecting the femur (thigh bone) to the tibia (shin bone). The knee cap (patella) floats above the actual knee joint and is free to move when the knee is bent (extended). To control movement, the knee joint is bracketed by ligaments: the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the posterior cruciate ligament (PCL). All three ligaments can sustain injury, however, the ACL and MCL are more commonly injured. Changing or twisting direction rapidly, slowing down when running, and landing from a jump are often the causes of tears in the ACL. Athletes participating in skiing and basketball in addition to athletes wearing cleated shoes are susceptible to ACL injuries. Injuries to the MCL commonly are caused by contact on the outside of the knee while PCL injuries can occur when the athlete receives a blow to the front of the knee or makes a simple misstep on the playing field. Athletes engaging in contact sports such as football or soccer are susceptible to a these injuries.

From Pointe to Patellar Dislocation

While performing a routine dance turn – a move she must have made hundreds of times before – Megan Wainwright’s foot stuck to the floor but the rest of her body kept moving. She knew right away that the pain in her knee was serious.

“It felt like a pop at first and I fell to the ground. It was a constant ache,” Wainwright said. “I thought it was dislocated, it just felt like it. I had my hand underneath it so I could feel it.”Wainwright, 17, Chili, danced for 13 injury-free years before suffering her first injury ever on Thursday, March 15. Wainwright dislocated the patella in her left knee during the last 15 minutes of dance class; she had been through two hours of play practice then a 45-minute dance warm-up.

The patella, or knee-cap, is a vital part of the knee joint, and dislocation of the patella is extremely rare: this injury accounts for just 43 out of 100,000 cases in men and women. In terms of what it feels like to have a dislocated patella, imagine a desk drawer being pulled hard enough to make it come off of its tracks—it is unnatural and difficult to readjust it. It is not difficult to relocate the patella, but it is certainly painful.

Wainwright was on the floor in her dance studio, A Time For Dance in Chili, when the ambulance came. The medics splinted her leg as it was, took her to the hospital, then relocated her knee. Wainwright rejected the painkillers she was offered, though. “I just wanted [my knee] back in and I figured I could take it because I’d already gone through an hour of waiting,” Wainwright said.

Wainwright made an appointment to see Dr. Mark Mirabelli, an orthopaedic specialist at University Sports Medicine on Monday, March 19. She did not want to return to the Emergency Room, but she could not wait to get medication for the pain. Dr. Mirabelli put Wainwright’s knee in an immobilized brace, gave her crutches, and started Wainwright on a physical therapy plan the following day.

“At first I couldn’t bend my knee, so I had to swing out my leg which bothered my hip a lot,” Wainwright said. “Then they got me into a better brace and it wasn’t as much of a problem. It’s really easy to move around in [the new brace].”

Wainwright now wears a simple ACL brace which allows front to back movement, but protects against the painful side-to-side movement.

Chelsea Sanders, a junior at Edison Tech in Rochester, suffered from a similar injury to Wainwright’s. Sanders had played basketball for seven years without injury when she felt her knee pop out of place in February. After a trip to the emergency room, a series of x-rays and an MRI, doctors determined that she had bruised her meniscus.

The meniscus is cartilage in the knee that serves as a cushion for the joint. It is located between the femur, or thigh bone, and the tibia, or shin bone, and improves the way these bones fit together. Injury to this part of the knee usually occurs when the joint is compressed and twisted, which can pinch the meniscus and sometimes result in a tear.  Sanders did not go through physical therapy – instead she rested and iced her knee – but the injury made her much more aware of the dangers that playing sports presents.

Wainwright’s injury required twice-a-week physical therapy, which involved a lot of stretching, thigh- and calf-strengthening activities, jumping and running. Also, she was given exercises to do at home four times a day when she first started therapy, but now she only has to do them once a day.  “I think my recovery has been going a lot faster than [Dr. Mirabelli] thought it would because I’ve been doing a lot at home,” Wainwright said.

Wainwright missed five days of school after her injury, mostly because the pain was unbearable. “I tried to go back one day, but it was too hard to get around the [school] halls on crutches, so I missed another day,” Wainwright said.

Inspired to dance by a babysitter, Wainwright began dancing when she was 4 years old. She grew to love the activity, and has not stopped dancing since. She practices a myriad of dances, including tap, jazz, ballet, modern, African, hip-hop and Pointe – her favorite – for approximately six hours each week. She was also in her school’s play, Footloose, so that tacked on another eight hours of dance, although it was less strenuous than her classes.

As she recovers from her injury, Wainwright admits that it has caused a number of changes in her life. This is the longest period she has ever gone without dancing – “It’s really hard to stand there and watch,” Wainwright said – and she is preoccupied and more cautious about her knee. Even walking up a flight of stairs and getting out of bed have become activities that she must focus on fully to perform.

  “It takes about 8-12 weeks assuming there is no other associated cartilage or other injury,” Dr. Mirabelli said. “Almost all athletes will be able to rehab enough to attempt a return but anywhere from 15-45% will have another dislocation and up 30-50% will have chronic knee pain.”

A Time For Dance’s upcoming annual recital is the first weekend in June and Dr. Mirabelli expects Wainwright to be able to participate. Right now, Wainwright is performing simple exercises at dance class; she can warm-up and walk through the routines, but she is still unable to jump and turn.

Wainwright’s family has been particularly supportive of her injury even though they, too, have been affected by it. Her father, an EMT for the fire department, and her mother have been calm and helpful throughout the injury, the therapy and the recovery. But they have had to accommodate Wainwright’s new additions to her schedule. Wainwright’s younger sister, Amanda, 14, dances and plays other sports; she has had a number of knee and ankle problems and Wainwright’s serious injury has definitely made Amanda more conscious of her own knees.

Recovering from an injury

Properly treating an injury is important to getting back into the game. If it's a minor injury, like a sprained ankle, treating the injury may only require the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil, ice to deal with the swelling and pain, and some rest. However, more serious injuries require more than what you can find in your medicine cabinet. The next step of treatment is, generally, physical therapy. Physical therapy (PT) is often prescribed by a physician specializing in musculoskeletal problems, an orthopedic, or can be prescribed by a child's pediatrician or family doctor. The referring physician may also order a set of x-rays or an MRI to further examine the site of injury. Physical therapy is often not covered under most insurance plans, but requires a co-pay of $20 (depending on the plan).

At physical therapy, an individual regimen of treatment is created for each patient. The regimen is designed to decrease pain and strengthen the muscles around the joint and area of injury. Pain management may be dealt with higher dosage NSAIDs, heat packs, ice packs, administration of ultrasound waves to the injury site, or a cortisone shot. Ultrasound waves create internal heating of the muscle tissue which in turn causes the muscles to relax. Cortisone shots are typically a last-resort option for pain management. Cortisone shots are injected directly into the injury site, usually into the joint. In the human body, cortisone is a steroid produced by the adrenal glands, which sit atop the kidney, and is released into the blood when the body is under stress. Injectable cortisone is a close derivate of our natural cortisone, but is injected into the site of injury and lasts 6-8 weeks. Upon injection, the cortisone is mixed with a local anesthetic (similar to what the dentist uses) to provide instant relief. During the short-term effects of the cortisone, physical therapy is prescribed to re-strengthen the injured area as much as possible, with the hopes of not requiring a second cortisone shot.

To strengthen muscles, rehabilitation uses a lot of resistance training with weights and Thera-bands. Thera-bands are exercise bands that are used to increase strength, flexibility and balance. These bands come in different colors based on their tension level—the more stretchy the band, the easier to perform the exercise. Generally, the idea is to work up through the colors. Patients are prescribed exercises to conduct at home 2-3 times a day, with weekly evaluations at therapy. While undergoing PT, the patient may be restricted from engaging in certain exercises and movements until the therapist is confident that further injury will not result. This might include being benched for the season. Although being benched is never ideal, the risk of greater injury (and more bench time, even permanently) certainly outweighs the upset of missing a season. However, therapists know how eager athletes are to get back out on the field; they try to expedite the process in a way that doesn't compromise the healing, and thus risk re-injury.